Relationship between routinization of daily behaviors and medication adherence in HIV-positive drug users

Although lifestyle factors and routinization of daily activities are emerging as important variables in understanding and improving medication adherence, measures of these constructs remain crude and rudimentary. This study evaluated whether a brief, yet more comprehensive measure of the routinization of daily behaviors and activities is predictive of medication adherence. Participants with HIV and histories of drug dependency completed a 2-week practice trial that mimicked highly active antiretroviral therapy (HAART) (phase 1), followed by a 2-week observation of adherence to HAART (phase 2) for those who started antiretroviral therapy during the study. Fifty-one participants completed the study. Average electronic monitored adherence rate (proportion of prescribed doses taken) in the practice trial was 67% (standard deviation [SD] = 24), which was significantly correlated (r = 0.50; p< 0.05) with adherence to HAART. A high frequency of four daily activities (eating breakfast, watching favorite television program, attending meetings, sleeping at home) was associated with higher adherence, whereas a low frequency of having friends over to visit was associated with higher adherence; the composite score that combined these five activities, and represented the extent to which a patient's daily routine incorporated these specific behaviors, was highly correlated (r = 0.63, p < 0.001) with adherence. In a stepwise multiple regression analysis with several adherence correlates included as independent variables, the composite score was the best independent predictor of adherence, accounting for over one third (36%) of the variance. These findings suggest that the extent to which one's daily life is structured and routinized is an important factor in understanding medication adherence. The individual items of this scale as well as a composite measure may be used to predict adherence and inform strategies to enhance adherence via recommended changes in the patient's daily routine.